Calcifications in pituitary adenomas

doi:10.1016/S0090-3019(81)80003-1

Surgical Neurology

Volume 15, Issue 4, April 1981, Pages 249-255

https://doi.org/10.1016/S0090-3019(81)80003-1 Get rights and content

In a surgical series of 755 pituitary adenomas, 51 cases (6.75%) showed intratumoral calcifications on microscopic examination and 13 of these were visible on roentgenographic examination (1.72%). Thirty-eight of these 51 cases were prolactinomas, the highest incidence being in male patients. There was no correlation between age, sex, levels of hormone, size of the tumor, and the presence of calcifications. Four patterns of radiological calcifications were encountered. Histologically, the calcifications were most frequently found within the tumor masses. Their rate occurrence within fibrous or degenerative areas speaks against their dystrophic nature. Previously reported calcified bodies in fetal and newborn pituitaries and the recently described physiological hyperprolactinemia in early infancy suggest a possible hormonal influence in the genesis of calcifications in prolactinomas.

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Cited by (37)

Endoscopic Endonasal Removal of Large Calcified Pituitary Adenoma: Case Report and Review of the Literature
2019, World Neurosurgery
Citation Excerpt :
At present, only approximately 50 cases of calcification in pituitary adenomas have been reported. Among them, we identified 32 cases in which the diagnosis of pituitary adenoma with calcification was pathologically confirmed.1-23 The calcification in these cases presented in a curvilinear or granular pattern.
Large calcified intrasellar masses, called pituitary stones, have been reported as calcified pituitary adenomas in the literature. Although relatively rare, calcified pituitary adenomas appear in various formations. Thus, whether the lesion is removable—and, if so, which approach is appropriate—mainly depends on its formation and quality.
A 46-year-old woman presented with visual loss and amenorrhea. Although computed tomography showed a uniformly calcified sellar tumor, magnetic resonance imaging displayed heterogenous intensity on T2-weighted images and mild gadolinium enhancement, suggesting that the lesion was a mixture of pituitary adenoma and fine calcification. Thus, we undertook tumor resection via an endoscopic endonasal approach, which resulted in total removal. The pathological diagnosis was a pituitary adenoma with rich calcification.
We report a rare case of a large pituitary stone that was successfully removed via an endoscopic endonasal approach. This could therefore be a feasible, effective technique for the removal of pituitary stones, although careful analysis of preoperative magnetic resonance imaging is required.
Gigantism in a McCune-Albright's syndrome with calcified GH-releasing pituitary adenoma: Case report and literature review
2018, International Journal of Surgery Case Reports
Citation Excerpt :
Nevertheless, the presence of dystrophic calcification associated to PA is a very rare condition that has been described in 6.75% of the series [10], but never in the context of a MAS. Identifying dystrophic calcifications in a PA in the preoperative imaging studies may represent a key role on the surgical decisión, since the scope in achieving a gross total resection can be more difficult to accomplish in the occurrence of extensive calcification [6,11]. Medical treatment has been the only option in MAS patients with GH excess mainly because the transsphenoidal surgery is quite and hardly restricted due to the massive thickening of the skull base [12].
McCune-Albright’s syndrome (MAS) is a rare disorder that is characterized by café-au-lait macules, fibrous dysplasia of the skull and endocrinopathies like excessive secretion of growth hormone by a hyper-functional pituitary adenoma (PA).
We describe the case of a 43-year-old male with history of Gigantism in 1990 secondary to a GH-secreting pituitary macroadenoma that was treated via microscopic transsphenoidal surgery at that time.
He was reported as asymptomatic for 26 years until he developed headache and right temporal hemianopia with left amaurosis. Also ptosis and proptosis was found caused by a re-growth of the tumor on the follow up MRI.
A second surgical procedure was performed via a dorsolateral craniotomy. Gross total resection was also achieved with a Neuropathology report of a pituitary adenoma tissue accompanied by extended dystrophic calcification and bone formation.
This is a rare case of MAS. Gigantism within the context of a pituitary calcification raises special diagnostic and therapeutic challenges. The cause of the excessive secretion of GH in MAS is not well understood concluding that it seems to be a different etiology of patients with Acromegaly and Gigantism in non-MAS patients.
Diagnostic significance of T2W hypointensity of the sella
2009, Journal de Radiologie
Normal anatomical structures and lesions characterized by low T2W signal intensity are reviewed in this pictorial essay. The purpose is to demonstrate how evaluation of the appearance, shape and exact anatomical location of the T2W hypointense sellar region structure, correlated with its T1W signal intensity, can based on the clinical context lead to an appropriate differential diagnosis.
Les structures anatomiques normales et les lésions des régions sellaire et parasellaire présentant un hyposignal T2 sont présentées dans cette revue iconographique. L’objectif est d’illustrer comment l’analyse de l’aspect, de la forme et de la topographie exacte d’un hyposignal T2 dans la région sellaire, confrontée à son signal en T1, permet en fonction du contexte clinique, de proposer une orientation diagnostique précise.
Microcalcifications in the anterior pituitary gland of the fetus and the newborn: A histochemical and immunohistochemical study
1999, Human Pathology
Calcified concretions are a normal and constant finding in the anterior pituitary gland of fetuses and newborns. Their light and electron microscopic characteristics have been recently reported by the authors. In this study, undecalcified and decalcified sections from 20 neonatal and 60 fetal anterior pituitary glands were studied by histochemical and immunohistochemical methods to further clarify their nature and mechanism of formation. All the glands revealed homogeneous and/or laminar calcifications located either within the interstitium or follicular structures. They were composed of a diastase-resistant periodic acid-Schiff—positive carbohydrate-rich matrix. The Feulgen method for DNA was negative. Their core frequently reacted to Alcian blue and epithelial membrane antigen (EMA). EMA also stained the apical membranes of adjacent epithelial cells. Other immunostains (vimentin, keratin, and pituitary hormones) were negative. The positive staining for Alcian blue and EMA and the negative staining with the Feulgen method for DNA suggest that the core of the calcifications consists of acidic mucosubstances and EMA-positive proteinaceous material previously secreted by viable pituitary cells. The EMA-negative periphery of the concretions probably develops from further extracellular peripheral mineralization that leads to larger, sometimes laminated psammoma bodies. The occurrence of pituitary calcifications in states of adult physiological and pathological hyperprolactinemia suggests that the marked proliferation of lactotrophs occurring during the fetal life play an important role in the pathogenesis of the fetal and neonatal concretions.
Calcified concretions in the anterior pituitary gland of the fetus and the newborn: A light and electron microscopic study
1996, Human Pathology
Calcified concretions including typical laminated psammoma bodies can be detected on routine hematoxylin-eosin (H&E) examination of fetal and neonatal anterior pituitary glands. This finding has seldom been reported in the literature and, to the authors' knowledge, no ultrastructural examinations of fetal or neonatal pituitary calcifications have been reported to date. In this study, histological sections of anterior pituitary glands from 200 fetuses and infants ranging in age from 15 weeks of gestation to 1 year of life revealed calcified concretions in all the cases up to 1 month of life. They decreased in incidence postnatally and were not found after 6 months of age. Most were round to ovoid, basophilic or eosinophilic, often laminated, and measured between 5 and 30 μm in diameter. Immunohistochemical stains showed that the calcifications followed no particular pattern of distribution among the most prevalent pituitary cell types. Ultrastructural examination revealed small single or multiple intracellular calcified deposits, and larger, sometimes laminated, extracellular calcifications, suggesting an intracellular origin for the concretions with cell death occurring concomitant with their formation. This phenomenon, which to some extent resembles the formation of psammoma bodies in certain tumors, seems to represent a distinctive morphological type of developmental cell death. Apoptosis, a more common form of developmental cell death, was also found in some of the sections. Pathologists should be aware of the fact that calcified concretions represent a normal finding in the anterior pituitary gland of fetuses and young infants. Their mere presence in cases of fetal or perinatal demise with no other pertinent findings should not be attributed to intrauterine viral infections or ischemic-anoxic events.
Ossified somatotropinoma
1994, Surgical Neurology
Calcification of pituitary adenomas as a histopathologic finding is reported in up to 25% of all degenerated adenomas. On the other hand, ossification of these adenomas is an extremely rare finding, with only one reported case, a prolactinoma. Here, we report a case of somatotropinoma in a 42-year-old acromegalic female. The adenoma, about 2 cm in diameter, was removed by the transsphenoidal route. Pathologic examination revealed ossification areas in the adenoma and the patient showed dramatic progress with relief of acromegaly signs and normalization of serum growth hormone levels. This case seems to be a unique report of osteoid metaplasia of a somatotropinoma.

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^*: This work was supported by the Pituitary Research Foundation (Grant no. 6619) and the Notte-Dame Foundation.

^*: During his training in Montreal, Dr. Rillier obtained a research scholarship from the Societe Academique, Geneva, Switzerland.

^†: Research Fellow of the Medical Research Council of Canada.

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Calcifications in pituitary adenomas*

Fertil Steril

Intrasellar amvloid tumor

Acta Neuropathol (Berlin)

Pituitary adenoma producing amyloid-like substance

Arch Pathol

Calcification in chromophobe adenoma. Case report

Br J Radiol

Significance of intracranial calcifications in toentgenologic diagnosis of intracranial neoplasms

Radiology

Le calcificazioni negli adenomi ipotisari

Minerva Radiol

Calcification in a chromophobe adenoma. Case report

J Neurosurg

Subclinical adenoma of the pituitary gland

Am J Pathol

Pathology of the Central Nervous System

Note on calcification in pituitary adenomas

Endocrinology